Provider Demographics
NPI:1538220553
Name:LIZAMA, FLORENCIO TUDELA (MD)
Entity type:Individual
Prefix:DR
First Name:FLORENCIO
Middle Name:TUDELA
Last Name:LIZAMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:177 SUITE C CHALAN PASAHERU
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:671-647-6201
Mailing Address - Fax:671-647-0045
Practice Address - Street 1:177 SUITE C CHALAN PASAHERU
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-647-6201
Practice Address - Fax:671-647-0045
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-938207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine